title: Utility of surveillance cultures for antimicrobial resistant organisms in infants transferred to the neonatal intensive care unit.
abstract: BACKGROUND
  Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits and costs of different strategies have not been fully evaluated.
  
  
  METHODS
  We conducted a retrospective study in 2 level III NICUs from 2004 to 2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods. Risk factors, selected outcomes and laboratory costs associated with ARO colonization were assessed.
  
  
  RESULTS
  Among 1751 infants studied, the rate of colonization for methicillin-resistant S. aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods was 3%, 1.7% and 1%, respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at ≥ 7 days of life had 5.8 increased odds of ARO colonization compared with infants <7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection and duration of hospitalization compared with those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425.
  
  
  CONCLUSIONS
  The rate of colonization with AROs at transfer was low particularly in infants <7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants.
authors.affiliation: From the *Department of Pediatrics, Columbia University Medical Center; †Department of Pediatrics, Cornell University; ‡Columbia University School of Nursing; §Department of Pathology, Columbia University Medical Center; ¶Department of Clinical Microbiology, New York-Presbyterian Hospital, Columbia University Medical Center; ‖Department of Infection Prevention and Control, New York-Presbyterian Hospital; **Department of Pathology, Weill Cornell Medical Center; and ††Department of Clinical Microbiology, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Theodore
authors.initials: T
authors.lastname: Macnow
authors.forename: Dana
authors.initials: D
authors.lastname: O'Toole
authors.forename: Patricia
authors.initials: P
authors.lastname: DeLaMora
authors.forename: Meghan
authors.initials: M
authors.lastname: Murray
authors.forename: Kristina
authors.initials: K
authors.lastname: Rivera
authors.forename: Susan
authors.initials: S
authors.lastname: Whittier
authors.forename: Barbara
authors.initials: B
authors.lastname: Ross
authors.forename: Stephen
authors.initials: S
authors.lastname: Jenkins
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Duchon
mesh_terms: D001431:Bacteriological Techniques; D002353:Carrier State / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D007363:Intensive Care Units, Neonatal; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010360:Patient Transfer; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*